The recent article by Grudzen et al.1 is an important look at the workplace safety of pornography performers in the United States. We are concerned, however, that its portrayal of condom use in pornography viewed by men who have sex with men (MSM) may be inaccurate and thus may divert attention from an issue with important public health implications. The authors report that 80% of penile–anal contacts in male homosexual pornography were protected by condoms; we believe that the frequency of protected sex in male homosexual pornography may be much lower, especially if one considers all forms of video pornography viewed by MSM.
Gonaives, Haiti. “No Mercy: Hurricane Season '08.” Medical Technician Aucy Saint-Aude conducts preliminary tests on a young woman at a school-turned-clinic for Doctors Without Borders. Photograph by Patrick Farrell. Copyright 2008 by The Miami Herald. Printed with permission.
Grudzen et al. analyzed only pornography available on DVD. A substantial proportion of pornography, however, is produced for Internet distribution only. 42% of Internet users in a recent survey reported viewing pornography online during the prior 12 months, an unknown portion of which was distributed only online.2 Grudzen et al. surveyed a limited catalog of DVD offerings, which may have underrepresented “bareback” pornography (pornography depicting intentional condomless sex), a practice not uncommon among MSM.3,4 Internal penile–anal ejaculations also were excluded because the presence of a condom at ejaculation could not be verified with certainty. The researchers also defined “protected” as use of a condom for any duration. Each of these factors might have contributed to an overestimation of protected sexual encounters in male homosexual pornography.
We recently completed an Internet survey of 821 MSM at a high risk of HIV transmission or acquisition. A full report is in preparation, but 77.2% of respondents reported viewing “bareback” pornography in the last 90 days.
In sum, the portrayal of unprotected sex in pornography targeted at MSM may be more common than indicated by Grudzen et al. A comprehensive analysis is warranted, because the viewing of unprotected sex by MSM may lead to a community-wide impression that unprotected sexual practices are the norm. This perception may cause an increase in the frequency of unprotected sexual practices and thus increase the risk of acquisition and transmission of HIV, HIV superinfection, and other sexually transmitted infections.
Acknowledgments
This work was supported by grant P01 AI057127 and a grant from the Center For AIDS Research (P30 AI 27742) from the NAtional Institute on Allergy and infectious Diseases, National Institute of Health.
References
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